The overall goal of this program is to substantially reduce the mortality, morbidity, and costs of care in patients having cardiac surgery by implementing an interdisciplinary and multifaceted patient safety program, demonstrated in CER to improve patient outcomes, in a cohort of hospitals. We will build upon our prior efforts to improve patient safety throughout the state of Michigan. We plan to use the same unit-based model to reduce morbidity and mortality in cardiac surgery by linking unit-based teams from the operating room (OR), intensive care unit (ICU), and floor within a hospital. We partnered with the Society for Cardiovascular Anesthesia Foundation (SCAF) and the Society for Thoracic Surgeons (STS) to conduct and spread this research. The STS has a mature database into which most hospitals performing cardiac surgery in the U.S. report data. Their approach to improvement is to send performance reports to hospital without offering improvement interventions (termed passive feedback) and benchmark data to teams. This approach contrasts with our Michigan project, in which teams actively implemented an interdisciplinary and multifaceted patient safety program and received feedback regarding performance. We hypothesize that the combination of feedback of performance data, as STS has done, with a multifaceted intervention demonstrated in CER to reduce infectious complications and a program to improve culture in cardiac surgery, will result in a greater reduction in 30-day mortality, length of stay, and readmissions than passive feedback alone. The specific aims of this proposal including the following; 1. To implement and evaluate the impact of a patient safety program on rates of surgical site infections and OR safety culture in a cohort of cardiac ORs. 2. To implement and evaluate the impact of a patient safety program on rates of central line-associated bloodstream infections, ventilator-associated pneumonia, and safety culture in cardiac surgical ICUs. 3. To implement and evaluate the impact of a patient safety program on errors associated with handoffs from the ICU to the floor and discharge from the hospital, and with safety culture in a cohort of hospital floors that care for cardiac surgical patients. 4. To evaluate the combined impact of a patient safety program in cardiac ORs, ICUs, and floors compared to passive feedback of outcome data on 30-day mortality, hospital readmissions, and hospital length of stay, in a cohort of hospitals providing cardiac surgery. This study has the potential to substantially reduce mortality, length of stay, and readmissions in cardiac surgery and to develop new knowledge regarding how to improve patient safety.